CMS Request for Comment on Model Applications and Documentation for Individuals and Small Businesses (SHOP) (PDF)"CMS is seeking public comment on the new single, streamlined application for health insurance and the SHOP applications in preparation for the launch of a new Health Insurance Marketplace next fall. Model applications and documentation for individuals and small businesses (SHOP) are now available for public comment via the paperwork reduction act (PRA).... SHOP applications for both employers and employees are posted in separate paperwork reduction act packages.... [1] Individual Application: Data Collection to Support Eligibility Determinations for Insurance Affordability Programs and Enrollment through Affordable Insurance Exchanges, Medicaid and Children's Health Insurance Program Agencies (CMS-10440); [2] SHOP Employer: Data Collection to Support Eligibility Determinations and Enrollment for Small Businesses in the Small Business Health Options Program (CMS-10439); [3] SHOP Employee: Data Collection to Support Eligibility Determinations and Enrollment for Employees in the Small Business Health Options Program (CMS-10438)"
(Centers for Medicare & Medicaid Services)

Labor Department Sharply Restricts Private Health Care Exchanges Using Individual Policies for Active Employees"[The DOL has] released additional guidance that clarified that pre-tax employer-sponsored HRAs cannot be used to help employees purchase coverage on the individual market without violating the ACA's prohibition on annual and lifetime benefit limits. This will significantly undermine the value proposition of using private exchanges featuring individual policies for active employees because it limits employer funding to dollars that would be taxable to employees."
(HR Policy Association)

[Guidance Overview]

DOL FAQs Address Deadline for Distributing Exchange Notices, HRAs and More"Hospital indemnity or other fixed indemnity insurance policies under a group health plan are excepted benefits (and not subject to HIPAA's portability rules) only if: [1] The benefits are provided under a separate policy, certificate, or contract of insurance. [2] There is no coordination between the provision of the benefits and an exclusion of benefits under any group health plan maintained by the same plan sponsor [and] [3] The benefits are paid with respect to an event regardless of whether benefits are provided for the event under any group health plan maintained by the same plan sponsor. To be hospital indemnity or other fixed indemnity insurance, the insurance must pay a fixed dollar amount per day, or other fixed period, of hospitalization or illness regardless of the amount of expenses incurred."
(Practical Law Company)

[Guidance Overview]

HRA Plans and the Prohibition on Annual Limits"This set of FAQs clarifies the certain 'integrated' Health Reimbursement Arrangements (HRAs) are not subject to the health care reform prohibition on annual limits -- HRAs that are 'integrated' with other coverage as part of a group health plan. An HRA that is not integrated with group health plan coverage is subject to the health care reform prohibition on annual limits unless certain exemptions apply. The guidance, however, does not discuss these other exemptions available to HRAs (small carve out of HRAs that are not subject to HIPAA Portability and the exemption for FSAs)."
(ftwilliam.com)

[Guidance Overview]

Implementing Health Reform: Additional Guidance Affects Use of Health Reimbursement Arrangements"The agencies intend to issue further guidance on the issue, but have concluded that stand-alone HRAs used to purchase individual coverage will not be considered to be integrated coverage that complies with the annual dollar limit requirement. Indeed, if employees are offered an HRA and group coverage, but decline the group coverage, the stand-alone HRA coverage will violate section 2711."
(Health Affairs Blog)

[Guidance Overview]

Agencies Issue FAQs Addressing Exchange Notice, HRAs, and PCORI Fees"[T]he agencies postponed distribution of [the notice to employees] to late summer or fall of 2013, so the notice could correspond with the open enrollment periods of the Exchange. The FAQs, also address stand-alone HRAs, generally providing that such arrangements will not comply with the prohibition on annual and lifetime limits unless integrated with other major medical coverage (that complies with annual and lifetime restrictions). In addition, the FAQs discuss fixed indemnity coverage and the exception for such coverage from ACA mandates, and the permitted use of ERISA plan assets to pay the Patient-Centered Outcomes Research Institute (PCORI) fee by the joint board of trustees of a multiemployer plan."
(Buck Consultants)

[Guidance Overview]

'Notice of Exchange' Deadline Postponed Until Further Guidance Is Issued"The new guidance states that the Department of Labor may issue a model Notice of Exchange along with the coming regulations, but in the meantime suggests that employers may want to adapt for this purpose a proposed template that summarizes employer-sponsored coverage options for purposes of determining eligibility for financial aid on the exchanges."
(E is for ERISA)

[Guidance Overview]

New Guidance Delays Effective Date for Employer Exchange Notification"The Department of Labor released a new set of Affordable Care Act FAQs on January 24, 2013, delaying the effective date for the employer exchange notice requirement and providing other useful guidance [described in a table in the linked article, entitled 'Other Useful Guidance On HRAs, Medicare Part D, Fixed Indemnity Insurance and PCORI Tax']."
(Seyfarth Shaw LLP)

[Guidance Overview]

Proposed ACA Rule on Employer Penalty Addresses Application to Multiemployer Plans"The proposed rule recognizes the unique role and structure of multiemployer plans and adopts an approach that should give contributing employers an incentive to continue their contributions to multiemployer plans. The multiemployer portion of the rule is proposed to be transitional through 2014, so further guidance will be necessary."
(Segal)

[Guidance Overview]

Final Rules Under HIPAA/HITECH Impact Employer Plans"The final rules expand individuals' rights to receive copies of their PHI by requiring covered entities to provide access to PHI in the electronic form and format requested by the individual, if the PHI is maintained electronically in one or more designated record sets (e.g., enrollment, payment, claims, and medical and billing records). Covered entities still have 30 days to respond to a request for PHI, even if the PHI will be sent electronically."
(Morgan Lewis)

[Guidance Overview]

Overview of the HIPAA/HITECH Act Omnibus Final Rule (PDF)"Now, as a result of the Omnibus Rule, covered entities and business associates would be liable for activities of their agents, regardless of their own compliance. The preamble states that the scope of agency is determined by the federal common law standard, specifically looking at whether the covered entity or business associate had the right to control the agent's conduct. HHS also stated that a business associate of a covered entity is not ordinarily an agent; however, it can become one depending upon the context of the relationship[.]"
(Alston & Bird)

[Guidance Overview]

Final HIPAA-HITECH Regs Address Privacy and Security of Health Information"The new regulations specify certain types of vendors, such as patient safety organizations and personal health record providers, that will be business associates when performing services for a covered entity. The new rules describe when certain data transmission vendors will be treated as business associates and when they will be mere conduits of information."
(Ballard Spahr)

Health Care Spending Continues to Increase But at Slower Pace"In more recent years, increases in health care spending have slowed down. The good news this month is that it is predicted to remain stable in 2013, even though, compared to other costs, it is still pretty high.... One of the biggest contributors to rising costs is prescription drugs. In [a recent] survey, prescription drugs costs were up 10.1 percent -- a 0.5 percent bigger increase than the year before.... But prescription drugs aren't the only factor."
(Idaho Business Review)

Consumers Need to Learn Obamacare Lingo"President Barack Obama's health care overhaul law has spawned its own jargon. With the law finally about to take full effect, consumers might want to get familiar with some of the terms[.]"
(The New York Times; free registration required)

Religious Groups and Employers Battle Contraception Mandate"In recent months, federal courts have seen dozens of lawsuits brought not only by religious institutions like Catholic dioceses but also by private employers ranging from a pizza mogul to produce transporters who say the government is forcing them to violate core tenets of their faith. Some have been turned away by judges convinced that access to contraception is a vital health need and a compelling state interest. Others have been told that their beliefs appear to outweigh any state interest and that they may hold off complying with the law until their cases have been judged. New suits are filed nearly weekly."
(The New York Times; free registration required)

Building State Health Insurance Marketplaces"Generally, states that administer their own [Pre-Existing Condition Insurance Plans] have had higher enrollment overall and as a percentage of their uninsured populations, especially early on. This may be because state policymakers were better able to target enrollment strategies.... This experience suggests that federally operated health insurance marketplaces will need to work with advocacy groups, hospitals, providers, and other stakeholders in the states to conduct effective outreach to potential enrollees."
(The Commonwealth Fund)

Can Narrow Networks Boost Exchange Coverage?"Narrow network plans, which some say are akin to the failed HMO experiment of the 1990s, are making a comeback. As insurers prepare to sell plans through health insurance exchanges, they're hoping these limited networks will appeal to a large number of new consumers.... And since many consumers shopping for health insurance through online marketplaces this October will be young and healthy, insurers expect they'll be more likely to welcome the lower cost, narrow network plans."
(FierceHealthPayer)

[Opinion]

Smokers Face Tough New Rules Under Obamacare"[T]he ACA allows payers to treat tobacco users very differently by opening the door to much higher premiums for this population. That measure has some health policy analysts cheering, suggesting that higher premiums are necessary to raise revenue for the law and (hopefully) deter smokers' bad habits. But other observers have warned that the ACA takes a heavy-handed stick to smokers who may be unhappily addicted to tobacco, rather than enticing them with a carrot to quit."
(The Health Care Blog)

[Opinion]

Text of ERIC Comments to EBSA Calling for Regulatory Flexibility in Implementing Workplace Wellness Programs (PDF)"ERIC suggests ... the following five changes[:] [1] Permit plans to use the reasonable valuation method best suited for a program, including actuarial valuation for programs with variable-value rewards; [2] Confirm that the costs of services or goods provided to, or utilized by, plan participants in a health-contingent program are not included in the value of the reward; [3] Accelerate applicability of the increased reward limits for all plans; [4] Strengthen disease management programs by resolving all conflicts between the reasonable design and reasonable alternative requirements and 'benign discrimination'; and [5] Retain a workable and effective definition of 'reasonable design.'"
(The ERISA Industry Committee)

[Opinion]

Supreme Court Snubs Citizens Whose Social Security Will Be Confiscated If They Refuse Government Health Care"Despite having paid thousands of dollars each in Social Security and Medicare taxes during their working lives -- for which they never sought reimbursement -- the five plaintiffs were told by officials at the Social Security Administration and Department of Health and Human Services that they had to forfeit all of their Social Security benefits if they wished to withdraw from (or not enroll in) Medicare.... The plaintiffs sought a judicial ruling that would prohibit SSA and HHS from enforcing these policies, which they believed conflicted with the Social Security and Medicare statutes. A sharply divided U.S Court of Appeals for the D.C. Circuit eventually upheld [the policies]. By its decision not to hear the case, the Supreme Court let that controversial ruling stand."
(Cato Institute)

Benefits in General; Executive Compensation

[Official Guidance]

Text of EBSA Notice Describing Changes to Delinquent Filer Voluntary Compliance Program"This Notice describes changes to the ... Delinquent Filer Voluntary Compliance Program [or 'DFVC'].... The Department's DFVC Program website has been updated periodically since 2002 to reflect the adoption of technical changes to the Program. Most recently, the DFVC Program website was updated to reflect the Department's final regulation mandating electronic filing of annual reports as part of the implementation of a wholly electronic ERISA Filing Acceptance System (EFAST2) for those reports.... This Notice also describes an existing online penalty calculator and Internet-based payment system for the DFVC Program.... This Notice is intended to be a comprehensive update and restatement of the DFVC Program that incorporates the changes that have been made in the DFVC Program since the 2002 Notice."
(Employee Benefits Security Administration)

[Guidance Overview]

Disclosing Compensation Consultant Conflicts"The SEC has added new Item 407(e)(3)(iv) to Regulation S-K requiring that a financial institution holding company include a disclosure in the annual proxy statement addressing whether the work performed by any compensation consultant raised a conflict of interest and, if so, the nature of the conflict and how it was addressed.... Disclosure is required in a proxy statement filed with respect to any annual shareholders' meeting at which directors will be elected occurring on or after January 1, 2013."
(Vorys, Sater, Seymour and Pease LLP)

[Guidance Overview]

Complying with New Compensation Committee and Compensation Adviser Independence Standards"Complying with these proposed amendments will require that financial institution holding companies amend the (or, in some cases, adopt a) compensation committee charter and take certain other actions, as described [in this article], beginning in mid-2013. These compensation committee requirements apply only to financial institution holding companies whose securities are traded on the national securities exchanges ... Other financial institution holding companies and financial institutions should keep these standards in mind as 'best practices' and be prepared for the possibility that similar requirements may be imposed through the bank regulatory process."
(Vorys, Sater, Seymour and Pease LLP)

Executives Should Reconsider Qualified Plans"The American Taxpayer Relief Act of 2012, while keeping federal income tax rates the same for almost all Americans, significantly increased ordinary income and capital gains rates for executives and other high earners. By raising the threshold at which top rates apply, the Act makes deferring compensation attractive, because there is more likelihood the compensation may be subject to tax at lower marginal rates when it is received,"
(PLANADVISER.com)

LIMRA Study Finds Most Small Businesses Do Not Offer Employee Benefits"Only 47 percent of small businesses (2-99 employees) in the United States offer benefits to their employees, the lowest level in two decades of LIMRA research.... 78 percent of small businesses in the U.S. are family-owned. Family-owned firms experienced a sharper decline in benefit penetration between 2005 and 2012 than non-family-owned firms, with only 40 percent of these businesses offering insurance benefits in 2012 (compared with 47% in 2005)."
(LIMRA)

Investors Worry More About Long-Term Care Than Retirement Planning"[In a recent study,] investors were asked, How worried are you about each of the following regarding your personal finances? The most common response was 'being able to afford healthcare and the support I need in my old age,' which had 26% of respondents 'highly worried.' Down the line, in fifth place, was 'having enough money set aside for retirement,' with 14% of investors highly worried about their retirement funds."
(Financial Planning)

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